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Any cause of hypercalcemia, most commonly primary or secondary hyperparathyroidism , can cause metastatic calcifications and abnormal pulmonary uptake. Metastatic osteosarcoma, neuroblastoma , radiation pneumonitis, and rarely bronchogenic carcinoma may demonstrate increased uptake of bone tracers. Accumulation of Tc-99m diphosphonate is also seen in pleural effusions, usually malignant.
Primary hyperparathyroidism.
The scintigrams (posterior (A) and anterior (B) projections) shows
diffuse increased radionuclide uptake in the lungs and stomach, that
represents metastatic calcifications, in a patient with parathyroid
adenoma.
Osteosarcoma with pulmonary metastases
This bone scintigram in posterior projection demonstrates foci of
abnormally increased radiotracer activity in the left hemithorax, in a
patient with known osteosarcoma.
Neuroblastoma.
This scintigram shows intense uptake in the mediastinum. Thirty-five
to 74% of primary neuroblastomas accumulate bone agents, presumably
secondary to dystrophic calcifications in the tumor.
Malignant pleural effusion.
The bone scintigram (A) shows diffuse accumulation of the radiotracer
in a malignant pleural effusion within the right hemithorax of this
patient with lung carcinoma. A CT scan (B) confirms the presence of a
right-sided pleural effusion.
Malignant pleural effusion
Anterior (A) and posterior (B) bone scintigrams show generalized
increased radionuclide accumulation in the left hemithorax in this
patient with lung carcinoma. A chest X-ray (C) confirms the presence of
a left-sided pleural effusion.
Seminoma
(A) The bone scintigram in anterior projection demonstrates abnormally increased radionuclide activity in the mediastinum. There is a bulky soft tissue mass occupying the mediastinum on this axial CT (B) of the chest, that displaces the thoracic aorta posteriorly. The mediatinal mass is biopsy-proven seminoma.
Urine Contamination
(A) Initial bone scintigram in anterior projection shows several ill-defined areas of radiotracer accumulation that subsequently disappears on repeat scan (B) following decontamination.